Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.
Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Saint Joseph Health, Portland, OR, USA.
Ann Surg Oncol. 2022 Oct;29(10):6299-6310. doi: 10.1245/s10434-022-12190-z. Epub 2022 Jul 27.
Randomized, controlled trials comparing breast-conserving therapy (BCT) with mastectomy have demonstrated equivalent overall survival (OS), but recent observational studies have shown improved OS in patients undergoing BCT. These studies provide limited data on young patients who are traditionally offered mastectomy due to perceived higher disease risk. This study examines the OS in a contemporary series of young women with breast cancer undergoing upfront BCT compared with mastectomy.
Women ≤40 years old with primary invasive T1-T2, N0-N1 breast cancer were identified from the National Cancer Database between 2006 and 2016. Patient cohorts were based according to locoregional treatment: BCT, mastectomy alone (Mx), and mastectomy with radiotherapy (Mx/RT). Kaplan-Meier method followed by Cox proportional-hazards regression with inverse probability of treatment weighting (IPTW) were performed to account for treatment selection bias effects in OS.
A total of 15,611 patients met the study criteria; 9,509 patients (60.9%) had BCT, 4,020 (25.8%) had Mx/RT, and 2,082 (13.3%) had Mx alone. The median follow-up was 4.6 years (interquartile range [IQR] 3.0-6.4). After IPTW-adjustment, the 5-year OS was similar for BCT (95%), Mx (95%), and Mx/RT (94%), and there was no significant difference in OS in Mx (hazard ratio [HR] = 1.16, 95% confidence interval [CI] 0.90-1.51) and Mx/RT (HR = 1.08, 95% CI 0.88-1.34) compared with BCT. Mx/RT was associated with decreased survival in patients with pT2N0 (HR = 1.78, 95% CI 1.12-2.84).
Among young patients with early-stage breast cancer, overall survival was equivalent regardless of surgical approach. Breast-conserving therapy remains a safe option in young women despite the clinical tendency to offer upfront mastectomy in young patients.
与乳房切除术相比，随机对照试验比较了保乳治疗（BCT），并证明了总生存（OS）相当，但最近的观察性研究表明，接受 BCT 的患者的 OS 有所改善。这些研究提供了关于由于认为疾病风险较高而传统上接受乳房切除术的年轻患者的有限数据。本研究检查了 2006 年至 2016 年间国家癌症数据库中接受直接 BCT 的年轻女性乳腺癌患者的 OS 情况，与乳房切除术进行了比较。
从 2006 年至 2016 年的国家癌症数据库中确定了年龄≤40 岁的原发性浸润性 T1-T2、N0-N1 乳腺癌患者。根据局部区域治疗，将患者分为 BCT、乳房切除术单独（Mx）和乳房切除术联合放疗（Mx/RT）。采用 Kaplan-Meier 法，然后采用逆概率治疗加权（IPTW）的 Cox 比例风险回归法，以纠正 OS 中治疗选择偏倚的影响。
共有 15611 名患者符合研究标准；9509 名患者（60.9%）接受了 BCT，4020 名患者（25.8%）接受了 Mx/RT，2082 名患者（13.3%）接受了 Mx 单独治疗。中位随访时间为 4.6 年（四分位距 [IQR] 3.0-6.4）。经过 IPTW 调整后，BCT（95%）、Mx（95%）和 Mx/RT（94%）的 5 年 OS 相似，且与 BCT 相比，OS 无显著差异 Mx（危险比 [HR] = 1.16，95%置信区间 [CI] 0.90-1.51）和 Mx/RT（HR = 1.08，95%CI 0.88-1.34）。在 pT2N0 患者中，Mx/RT 与生存率降低相关（HR = 1.78，95%CI 1.12-2.84）。
在早期乳腺癌的年轻患者中，无论手术方式如何，总体生存率均相当。尽管年轻患者中存在临床倾向于行乳房切除术的倾向，但保乳治疗仍然是年轻女性的安全选择。
